April 27, 2010, Elsevier

According to the United States Department of Agriculture, about half of U.S. children between birth and age 5 receive services from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). With more than 8.2 million low-income women and children receiving services in 2009 alone, it is imperative that nutrition education, which is required as part of the WIC services, effectively encourages healthful eating. A study in the May/June supplement issue of the Journal of Nutrition Education and Behavior examines the impact of a new statewide WIC nutrition education curriculum in California that supports the 2009 revisions to the WIC food package (the addition of fruit, vegetables and whole grains, as well as lower-fat milk restrictions for women and children over 2 years of age).

Earlier studies of the effects of nutrition education on WIC participants looked at more intensive nutrition education than is mandated by federal WIC regulations; few focused on lower-fat dairy consumption and none on whole grain consumption. In the new study, researchers at the University of California-Berkeley and the Public Health Foundation Enterprises WIC Program examined the Healthy Habits Every Day nutrition education curriculum.

Prior to the 2009 food package change, 3,000 WIC participants (from all 82 California WIC agencies) were surveyed both before and after they received the new nutrition education. Questions were asked about recognition of education messages, willingness to change eating behaviors, and consumption of fruits, vegetables, whole grains, and lower-fat milk.

Fruits and Vegetables. Overall, participants' fruit and vegetable behaviors improved. Significant increases were observed for recognition of education messages on fruits and vegetables. In addition, participants reported their intention to eat more fruits and vegetables and the proportion of respondents who reported that their family was eating more fruits increased from before to after the nutrition education.

Whole Grains. After the nutrition education, there was an increase in nutrition education message recognition for all targeted nutrition behaviors except reading ingredient labels on packaged food. The number of WIC participants who said they had heard about the "importance of eating whole grains" from WIC nearly tripled after exposure to the education curriculum. Improvements in eating more 100% whole-wheat bread, eating brown rice instead of white rice, and eating whole-wheat instead of plain flour tortillas were also observed.

Low-fat Milk. Significantly more caregivers and children were drinking more lower-fat milk and less whole milk from before to after the nutrition education. These changes were observed for both Spanish- and English-speaking respondents.

The 3 nutrition topics in this WIC curriculum align with the 3 major changes in the WIC package. As WIC agencies promote the new healthful food items in the WIC package, this nutrition curriculum will potentially increase the consumption of fruits and vegetables, whole grains, and lower-fat milk.

"The nutrition education was designed to prepare participants for subsequent WIC food package modifications, providing an unprecedented opportunity to isolate the impact of nutrition education, separate from other WIC services," says lead author Dr. Lorrene Ritchie, Director of Research at the Dr. Robert C. and Veronica Atkins Center for Weight and Health at University of California-Berkeley. "Although several intervention studies have been designed to augment nutrition education in WIC, this intervention is unique in that delivery format and frequency were consistent with usual WIC practice."

"Coordinated statewide nutrition education was associated with consistent increases in respondent recognition of key education messages, improved intention of behavior change, and reported increases in family consumption of fruit, whole grains, and lower-fat milk," says co-author Dr. Shannon Whaley, Director of Research and Evaluation at the Public Health Foundation Enterprises WIC Program.

This study documents that nutrition education in WIC can impact participant knowledge, attitudes, and behaviors to support the consumption of a more healthful diet.

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